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July 2016


CMS Proposes Additions to Medicare's Telehealth Services







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Laura Little


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Cybil G. Roehrenbeck


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Sidney Welch


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On July 7, the Centers for Medicare and Medicaid Services (CMS) released the CY2017 Physician Fee Schedule Proposed Rulei, which, in addition to updating payment rates, proposes to expand marginally the list of telehealth services eligible for Medicare reimbursement. The proposed changes do not represent a marked change from CMS' historical policies regarding telehealth reimbursement. Rather, these changes hint at CMS' greater willingness to accommodate and encourage providers' adoption of such technologies to expand access to quality care for rural beneficiaries. Additionally, CMS suggests modifications to current policies on Place of Service (POS) coding and clarified current payment policies for telehealth services rendered in hospitals. Comments on the proposed rule are due on September. 6, 2016.

Medicare Telehealth Services List:

Starting in CY2017, CMS is proposing to add several services to the list of telehealth services eligible for Medicare reimbursement when provided in accordance with all pre-existing legal requirementsii, including:

  • ESRD Related Services
  • Advance Care Planning Services
  • Critical Care Consultations Furnished Via Telehealth
    [Expand list]

CMS considered, but rejected, requests to add the following CPT codes to the list of eligible telehealth services:

  • Observation Codes
  • Emergency Department E/M Services
  • Psychological Testing
  • Physical Therapy, Occupational Therapy, and Speech-Language Pathology Services
    [Expand list]

Place of Service (POS) Code Suggestions

Although the POS workgroup establishes policies for POS code usage, CMS proposed various modifications to existing POS code policies for reporting telehealth services to allow for possible future POS workgroup decisions governing appropriate coding, which might occur before January 1, 2017. Specifically, CMS proposed to require practitioners furnishing telehealth services to report the POS code it would use if the services were furnished in-person (i.e., the patient location) so as to indicate that the services were provided via telehealth. On receipt of such claim, CMS also proposed to use the facility practice expense relative value units (PE RVUs) to reimburse for the telehealth services reported. Meanwhile, CMS suggested that POS Code usage for the originating site remain unchanged the originating site should continue to bill for the facility fee and continue to use the POS Code applicable to the patient's location (facility or non-facility) so as to receive the correct reimbursement rate (either facility PE RVU or non-facility PE RVU).

Policy Clarification: Hospital Telehealth Services

Finally, CMS proposed revisions to existing regulations to clarify that, when telehealth services are furnished in a hospital and the hospital is not being paid for such services, payments under the physician fee schedule should be made at the facility rate (facility PE RVUs). This policy is not new but rather a restatement of CMS' existing stance on appropriate billing in such scenarios.

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For questions regarding this information, please contact one of the authors, a member of Polsinelli’s Health Care practice, or your Polsinelli attorney.



i Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for Calendar Year (CY) 2017 (proposed July 6, 2016) available here.

ii See 42 U.S.C. § 1395m(m); See also 42 C.F.R. § 410.78.

iii See Section 1834(m)(4)(E) of the Social Security Act as defined by Section 1842(b)(18)(C) of the Social Security Act.







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